1. Discuss the attempts made in the U.S. prior to the ACA to reform health care. What programs were successful and which were unsuccessful? 400-500 words APA format

2. Write a 3-5 page paper discussing the pros and cons of the Affordable Care Act (ACA). Discuss what changes you would make to the ACA if you were in charge of developing a repeal. APA format. scholarly articles/journals as references

The ACA changed the health insurance landscape through numerous new insurance protections that improved access to coverage for people with diabetes, as well as the quality of that coverage. Since the ACA passed in 2010, ADA has made great progress in ensuring that the law is implemented in a way that will benefit people with or at risk for developing diabetes and that these individuals are aware of the numerous improvements made by the law. Some of the health insurance improvements and advocacy victories include:

• Health plans cannot deny people coverage or charge them more because they have diabetes or any other preexisting condition.

• Plans cannot have annual or lifetime dollar limits on essential health benefits.

• The amount of cost-sharing that individuals and families pay for their care each year is limited.

   ❍ In 2015, after out-of-pocket spending of $6,600 for individual coverage or $13,200 for family coverage, the plan pays 100% of the cost of covered essential health benefits.

• A Health Insurance Marketplace (Marketplace) is available in every state, through which individuals and families can shop for and buy health insurance. Marketplace plans are separated into four categories: Bronze, Silver, Gold, and Platinum. Moving from Bronze to Platinum, in general, out-of-pocket costs decrease and premiums tend to increase. People who meet income requirements qualify for assistance in paying their Marketplace plan premiums (through a tax credit) and may qualify for other assistance to lower their out-of-pocket costs when they access care.

   ❍ For example, in 2015, help in paying Marketplace premiums was available to individuals earning $11,770–$47,080 and families of four earning $24,250–$97,000. In addition, individuals earning up to $29,425 and families of four earning up to $60,625 were eligible for help paying cost-sharing expenses for certain Marketplace plans.

• Plans and issuers that offer dependent coverage are required to make the coverage available until adult children reach the age of 26.

• A minimum set of essential health benefits (EHBs) such as hospitalization, prescription drugs, chronic disease management, and preventive services must be covered in most individual and small-group plans, including all plans sold in the state Marketplaces.

   ❍ The design of a plan’s package of EHBs also cannot discriminate against individuals with a disability or chronic health care needs.

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• All plans must provide a plain-language summary (called a Summary of Benefits and Coverage [SBC]) of its benefits to help people better understand its coverage and compare plans.

   ❍ The SBC includes a coverage snapshot of how much the plan might pay for medical care for a sample patient with type 2 diabetes. ADA advocated for this example to be included in the SBC.

• Most plans must provide coverage of numerous preventive services without a copayment if the services are obtained through an in-network provider.

   ❍ Currently, plans must cover without cost-sharing type 2 diabetes screening for adults with high blood pressure, type 2 diabetes screening for pregnant women at high risk, and gestational diabetes screening for all pregnant women. ADA is working toward expanding the requirement for type 2 diabetes screening for all adults at high risk in accordance with ADA standards, and there is currently a draft recommendation from the U.S. Preventive Services Task Force to that end.

• The Medicare “donut hole” (a coverage gap in many Medicare Part D prescription drug plans that used to make beneficiaries responsible for 100% of the cost of their drugs above an initial coverage limit but less than the amount needed to trigger “catastrophic” coverage) is gradually closing and will no longer exist in 2020.

• Medicaid eligibility was extended to all Americans earning up to 138% of the federal poverty level (FPL; $16,243 for individuals and $33,465 for families of four in 2015), although, as a result of a 2012 Supreme Court ruling, this extension is optional for states. Currently, 30 states and the District of Columbia have expanded Medicaid.